【摘要】 目的探讨和评价近年来 Lecompte 术在小儿心室大动脉连接异常的先天性心脏病(先心病)中的临床应用价值。方法2000年1月至2006年4月18例心室大动脉连接异常的先心病病儿行Lecompte 手术治疗。年龄3个月～9.2岁;体重4.5～27.0kg。大血管转位(D-TGA)、室间隔缺损(VSD)、肺动脉狭窄6例,右心室双出口(DORV)5例,永存动脉干7例。6例 D-TGA 中主动脉和肺动脉呈前后位4例,另2例与4例 DORV 主肺动脉呈右前左后关系,1例 DORV 主动脉动脉呈左前右后关系。7例因位于两半月瓣之间的漏斗(圆锥)隔妨碍建立 VSD 和主动脉之间隧道,遂切除漏斗隔。8例行经典 Lecompte术,10例进行改良 Lecompte 术,前壁再用心包补片扩大。术毕病儿右心室和左心室收缩峰压比值(PRV/PLV)为0.20～0.45。结果所有病儿均生存,5例表现为右心功能不全,术后彩色超声检查,2例右室流出道压差30.0～34.5 mm Hg(1 mm Hg=0.133 kPa);2例行右肺动脉改良 Lecompte 术病儿压差37.5～47.3mm Hg。分别随访3个月、2年,此2例病儿右肺动脉残余压差24.0～29.3 mm Hg。结论 Lecompt 手术可以减轻左心室流出道梗阻,避免使用人工管道,采用自体肺动脉重建肺动脉流出道具有生长潜能,特别适用于婴幼儿、甚至新生儿。更多还原

【Abstract】 Objective To evaluate the surgical effect of Lecompte procedure for the abnormalities of ventriculoarterial connec- tion in congenital heart disease in infant and children.Methods 18 patients of abnormalities of ventriculoarterial connection of con- genital heart disease were operated in our hospital from March 1999 to December 2005.They aged from 3 months to 9.2 years and weighted from 4.5 kg to 27 kg.There were 6 cases of D-TGA with VSD and PS,5 cases of DORV and 7 cases of tnmcus arteriosus. The aorta was anterior to the pulmonary artery in 4 cases of D-TGA,and anterior and right to the pulmonary artery in 2 cases of D- TGA and 4 cases of DORV.The infundibular(conal)septum,located between the two semilunar valves,is aggressively resected a wide VSD to aorta tunnel can be constructed.8 cases were performed with original Lecompte procedure and 10 cases with modified one.The ratio of right to left ventricular was 0.2～0.45.Results All patients were alive.5 cases showed right ventricular dysfunc- tion in which 2 cases showed pressure difference in right ventricular outlet(RVOT)was 30.0～34.5 mm Hg.The other 2 eases showed pressure difference in RPA was 37.5-47.3 mm Hg and decreased to 24.0 ~ 29.3 mm Hg during the follow-up of 3 months to 2 years. Conclusion The Lecompte procedure not only alleviates the RVOT obstruction but also have the potential ability of growth.So it is suitable to the babies even the newborns and its long term results may be better than Rastelli procedure.更多还原